Thursday, May 29, 2008

Nip Cancer in the Bud - THE ANSWERS Part 2 of 2

This is the final installment of the Cancer Awareness series, answering the rest of the questions (with the exception of one that required more detailed information and got help up, but I will try to get it added later today) (it's in there now!) from y'all regarding breast and cervix cancers. If you missed Part 1, you can go here to read the answers you asked about skin and other types of cancer.

I have been amazed by the response to this campaign and I'm happy to say that I feel so blessed to have been a part of it. I have yet to meet a woman who doesn't know at least one other person who has or has had cancer.

We just learned last week that my MIL's aunt has relapsed and is now in her third round of chemo treatments for pancreatic cancer, which has a poor survival rate. Very few victims live longer than five years beyond initial diagnosis - my MIL's mother lasted just under 6 months. Cancer is a thief. I hate it - and with that being said, I am so thankful for the Drs that diagnose and treat it. I'd like to introduce you to a few more that have answered your questions with care and thought:

Three Texas Oncology physicians contributed to the answers for part two of “Nip Cancer in the Bud,” including Doctors Russell Hoverman, Debra Patt, and Carolyn Matthews.

J. Russell Hoverman,M.D., is a medical oncologist and is board certified in internalmedicine and hematology. Carolyn Matthews, M.D., a medical oncologist,specializes in gynecological oncology and is board certified in obstetrics andgynecology and gynecologic oncology. Debra Patt, M.D., M.P.H., specializes inmedical oncology and hematology, with a special interest in breast cancer,cancer prevention, outcomes-based research, and tobacco policy.

{For more information about cancer or to find a Texas Oncology physician in your area, visit www.TexasOncology.com or call 1-888-864-I CAN (4226). }

Blog Q & A – Breast Cancer, Cervix Cancer and Other Topics

1. Is breast cancer becoming more common, or is awareness simply better now?

While there has been a tremendous increase in awareness about breast cancer and the causes of breast cancer, there has actually been a reduction in the incidence by 3.5 percent a year, according to the American Cancer Society. The decrease could be a reflection of the reduced use of hormone replacement therapy. Breast cancer is still the second-deadliest cancer among American women. Nevertheless, women should continue to follow the recommended age-appropriate screenings for breast cancer, as early detection is truly the most effective way of combating the disease.

2. I understand that cancers are so varied, but could they touch on why 2 women, who both have breast cancer of the same nature, would have 2 completely different treatments? How do doctors decide what treatment works best?

Without knowing the complete details of each diagnosis, it’s challenging to say why a doctor chooses a certain treatment protocol. The type of treatment protocol really depends on a variety of factors, including the size of the tumor, its relative malignancy, and the patient’s personal medical and family history.

3. Last summer I found a large lump (walnut size) in my breast. Went to my doc, had a mammogram and ultrasound. They told me it was a cyst. It has not changed and several of my friends think I should have it checked further. I will return in late summer to my doc for my regular annual exam. Should I push for further testing or just accept that it's a cyst that's there for a while?

It is important for you to continue to monitor the lump through breast self-exams and be sure to note any changes in size. While cysts can linger in your body for years, you should be cautious if you see or feel any changes. Certainly, if you are not comfortable waiting for your annual exam or the explanations you have been given, you can seek a second opinion and further evaluation. Digital mammography often gives a better view of dense breast tissue, so be sure you are getting a digital mammogram on your next visit.

4. Why suggest a lumpectomy when it seems that "it" (the cancer) comes back anyway?

Many women prefer to have a lumpectomy, as this procedure preserves the nipple and much of the normal contour of the breast. Most of the time a lumpectomy is combined with radiation therapy to the breast to reduce the recurrence rate of the cancer. Survival statistics indicate that treatment with lumpectomy/radiation therapy in appropriately selected patients is associated with the same survival rates as more extensive surgery. Though breast reconstruction after mastectomy is an excellent treatment option, sensation and cosmetic appearance are best preserved with lumpectomy. There are, however, many instances where lumpectomy is not appropriate and is an important decision to be made with your surgeon.

5. I found you through Antique Mommy, and I have just finished treatment for Stage III Breast Cancer. I applaud your efforts to get the word out! While I have a great team of professionals here to draw from, I have gotten mixed messages about nutrition and dietary changes recommended for protection against recurrence. I already eat a fairly healthy diet and exercise regularly, and I've heard everything from “the only thing proven with breast cancer is that alcohol contributes” to “become a vegetarian". I would love to hear what the Texas oncologists would recommend. (see below for answer to both 5 & 6)

6. As oncologists, do you also stress the importance of diet in prevention AND treatment to your patients? My father died of cancer, and his oncologists never addressed this. I was furious with them, because if his “doctors” had said he needed to eat better, he probably would have listened.

Answer to both #5 & 6:Eating a healthy, balanced diet is important in both the prevention and treatment of cancer. General guidelines for nutrition include choosing a diet rich in a variety of plant-based foods, eating plenty of vegetables and fruits, drinking alcohol only in moderation, and selecting foods low in fat and sodium. There is no evidence that a vegetarian diet provides any more protection than a mostly plant-based diet with small amounts of meat. Eating well will also help you as your body recovers from cancer and you will feel better overall. It is always important to remember that there are many factors that are involved in a patient’s treatment and recovery and it is difficult to comment on your father’s case without knowing his full medical history. For more information from Texas Oncology about certain foods that have cancer-fighting properties, click here. It is also important to be physically active every day and to maintain a healthy weight.

7. I've heard that itchy breasts can be a symptom of breast cancer - is this true? I'm also breastfeeding so is it more likely that any itchiness is caused by milk flow/production?

Breast feeding can cause itchiness of your breasts, however, itchiness can also be a symptom of inflammatory breast cancer. Inflammatory breast cancer is a rare type of cancer that accounts for about 1 to 3 percent of all breast cancers. I would recommend that you discuss your concerns and symptoms with your obstetrician.

8. Got here via Antique Mommy. My question is this: what is the difference between "regular" breast cancer and IBC? Is IBC harder to diagnose?

Breast cancer is a malignant tumor that forms in the cells of the breast. Inflammatory breast cancer (IBC) is an uncommon, highly aggressive form of breast cancer in which there is not a single tumor or lump, but the cancer cells block the lymph vessels in the skin of the breast. Although there are others, the two primary symptoms of IBC are swelling and redness of the breast. IBC is more difficult to diagnose as it is not usually detected by mammograms or ultrasounds because of the fact that there is not a defined lump. More information on breast cancer and inflammatory breast cancer is available on the Texas Oncology Web site.

9. Also, are women who have never had children at a higher risk of having ovarian cancer?

Yes, pregnancy and the long-term use of oral contraceptives reduce the risk of developing ovarian cancer.

10. My question is: are there any reliable early screening tests for ovarian cancer?

In 2007, the Gynecologic Cancer Foundation announced the first national consensus on ovarian cancer symptoms. This announcement debunks the commonly held belief that ovarian cancer is a “silent killer” by revealing that there are symptoms that women can look for. Until now, early detection was difficult and therefore led to a reduced chance of survival. The symptoms include: bloating; pelvic or abdominal pain; difficulty eating or feeling full quickly; and urinary symptoms (urgency or frequency). Women who have these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist. Specifically to answer your question, there are no dependable screening studies, however, in high-risk women tumor markers and trans-vaginal ultrasound are often used.

11. If one has had one kind of cancer, say thyroid, is that any indication that she is more likely to get another kind of cancer at some point down the road?

There are many variables to determining if someone might develop another type of cancer in the future or if the current type of cancer will recur. Early screening is the most effective way to fight any type of cancer. However, as with any type of cancer, there is a risk that the disease can recur if it has spread or metastasized to other organs in the body. You should always be vigilant about screenings, especially if you have had a prior cancer diagnosis, and work with your physician to determine the best course of action to monitor for recurrences.

12. Another colon cancer question: A good friend of mine (two weeks shy of 26) has idiopathic gastroparesis and a family history of colon issues (not specifically cancer, to my knowledge). She recently had a colonoscopy due to some symptoms that had previously been attributed to her gastroparesis meds, and they found and tested polyps. The tests came back alright, but it sounded as though polyps are unusual in a 25 year old. How unusual/high risk is this?

A risk assessment cannot be made without a complete evaluation of a patient’s clinical state and family history. Polyps are uncommon in people under 40, but determining the risk depends on the number and type of polyp.

13. My dad has just been diagnosed with stage IV Renal Cell Carcinoma (kidney cancer) He has started chemo and is doing ok with it so far, although he is really sick and very tired. I am not able to go with him to the doctors and I am afraid that he is not telling me anything that is actual (just what he wants me to know). The cancer has spread to his spine, his liver and his lymph nodes. I want to know if this is treatable...he is very positive and he says he is going to kick it, but I am so worried about him. I just want some answers. He is the type of person to put a positive spin on everything and so I don't actually know if the doctors are actually this positive or not. My question is this: can you beat stage IV metastasized kidney cancer. Is this possible? Can he go into remission? I know this is a hard question, but I am in such desperate need of some answers. Cancer has so deeply touched my family. Both grandmothers (IBC), my mother (in remission) and now my father.

Chemotherapy is often used to treat kidney cancer that has spread beyond the kidney, and unfortunately nausea and vomiting, along with tiredness, are some of the more common side effects, but they should go away when his treatment is complete. There are many factors to assess when considering your father’s prognosis, and it is difficult to say what the outcome will be without knowing his full medical history. Your father’s outlook is very important, as a good attitude has shown to be a positive factor in fighting cancer. If you are not already, I would strongly encourage you to be sure you are taking care of yourself and that you are getting regular screenings for both kidney cancer and breast cancer. People with a family history may need to start recommended cancer screenings at an earlier age, primarily as a monitoring tool.

Honest communication among the physician, patient, and important family members is critical in caring for patients with cancer. When the disease may not be curable, the issues of pain and symptom control, family affairs, short- and long-term goals, and how best to live one’s life become paramount. You can ask your father’s permission to contact his physician to discuss the outlook for him. It is also important to discuss your father’s wishes for decision-making in the case that he cannot make decisions for himself in the future. Helpful Web sites about having conversations with patients with potentially incurable cancer are www.cancer.net/coping and www.AetnaCompassionateCareProgram.com.

14. A mole. or cancer? Cancer doesn’t run in my family, I don’t tan, and I am far from a sun worshiper. The second I step outside, I seem to get "sun spots" everywhere...large freckles, from my arms down my legs. I have had a mole on my neck for as long as I can remember...but recently, I feel like its changed. Now, that could be my paranoia or the fact that I don’t look at it that often because of its placement, or even due to the summer months...my question is, how do you KNOW when a mole has changed in a negative fashion? Dr visits are not cheap, and not easy w/ children, I just cant run to the dr all the time if its just sillyness. Here is a picture . DO I go? Or completely normal?

One simply cannot make a decision about a mole from a picture. Any mole of concern needs to be evaluated by your physician. However, it is good that you are aware of your skin and keeping an eye on any changes.

The ABCD rule can help guide you when checking your skin for changes:

A = Asymmetry: One side of the mole does not match the other in size, shape, color, or thickness.

B = Border: The edge or border of the mole may be irregular.

C = Color: The color of the mole is not uniform, various shades of brown and black may be present.

D = Diameter: Skin cancer melanomas are usually larger than 6 millimeters in diameter, but they can be smaller.

Pay careful attention to spots on your body and note what they look like, or you could even take photos as you have done of this mole, so you will have a comparison the next month. If you are concerned about a particular mole, it is always recommended that you seek an appointment with a dermatologist. The dermatologist will perform a thorough examination and record information about your skin for review during future appointments.

15. I have had three PAP smear/colposcopies that have come back “mild dysplasia” over the past 9 months. My doctor says we just need to keep testing as long as the “mild” doesn't elevate to “moderate.” Is there anything else I need to do? The Pap smear is only a screening test, and can be associated with both false positives and false negatives. Most patients with low grade dysplasia on their Pap tests should have a colposcopic exam, which uses a microscope to examine under magnification the cervix and the vagina. A colposcopically directed biopsy that shows mild dysplasia has a low likelihood of progressing to cancer and a high likelihood of regressing spontaneously, particularly in young patients. The American Society for Colposcopy and Cervical Pathology guidelines recommend a follow up Pap smear every six to 12 months with a repeat colposcopy if the Pap is abnormal. An alternate approach would be to perform a test for HPV DNA, and if that test is positive, to then repeat the colposcopy. Treatment is generally not recommended unless the mild dysplasia persists for two years or more, and even in that setting continued follow up is an option. Another setting where treatment would be considered would be when the dysplasia extends up into the endocervical canal, and cannot be viewed in its entirety with the colposcopy.

Here's the last button for your blogs if you would like to post so folks know to come back for the last of the answers:

5 comments:

Karen, you have provided such a valuable service to all of us! A huge THANK YOU from me to you! Once again, I've linked to your post (and used your cute little button) to get the word out as much as I can.